POS0151 PREGNANCIES IN PATIENTS WITH SPONDYLOARTHRITIS: DATA FROM 2 EUROPEAN CENTERS.
Authors: F. Crisafulli, A. R. Cruz-Machado, J. Rodrigues-Fernandes, M. C. Gerardi, S. C. Barreira, S. Grazioli, P. Martins, C. Zanardini, M. Centeno, S. Zatti, C. Araújo, L. Pinto, S. Capela, L. Andreoli, F. Franceschini, A. Tincani
Journal: Annals of the Rheumatic Diseases (2022)

Background There is growing interest in reproductive issues in patients with Spondyloarthritis (SpA) and Psoriatic arthritis (PsA). Objectives To describe a real-life cohort of prospectively-followed pregnancies in SpA and PsA patients, focusing on obstetric outcome and on flare during pregnancies and post-partum. Methods Data on SpA and PsA pregnancies prospectively-followed in 2 European pregnancy clinics from 2010 to 2021 were retrospectively analysed. Disease activity was assessed using ASDAS-CRP or DAS28-CRP according to the main involvement (peripheral or axial). Disease flare was defined as the need to treatment modification (introduction or increase ≥5mg/day of prednisone, introduction of cDMARD or bDMARD). Miscarriages were excluded from the analysis of flares. Results Data on 122 pregnancies (53 PsA and 69 ‘other SpA’: 39 axialSpA, 20 undifferentiated SpA, 6 IBD-related SpA, 4 reactive arthritis) in 102 patients (median age at conception: 34 [IQR: 31-36] years; median disease duration: 72 [24-132] months) were collected. We recorded 98 (86%) live births and 16 (14%) miscarriages (8 missing data). Cesarean section was performed in 15/98 (15%) cases. Median week of gestation at delivery was 39 [38-40]; 8 preterm births (&lt;37 week of gestation) and 2 severe preterm births (&lt;34 week of gestation) occurred. There was no difference between PsA or ‘other-SpA’ concerning pregnancy outcome and route of delivery. Fourty-two pregnancies (40%) had at least 1 flare during pregnancy; 7 pregnancies had more than 1 flare. Overall, there were 13, 24 and 12 flares in the 1 st , 2 nd and 3 rd trimester, respectively. A higher frequency of patients with axial involvement was observed in the ‘flare’ group as compared to pregnancies without flare (83% vs 59%, p=0.02) (Table 1). Table 1. Comparison between ‘flare’ and ‘without flare’ groups. FLARE (42) WITHOUT FLARE (64) p Age at conception (years) 33 (31-37) 33 (31-35) 0.88 Disease duration at conception (months) 71 (24-120) 60 (24-137) 0.74 PsA 13 (31%) 31 (48%) 0.11 ‘Other SpA’ 29 (69%) 33 (52%) 0.11 Axial involvement 35 (83% ) 38 (59% ) 0.02 Peripheral involvement 30 (%) 54 (%) 0.17 bDMARD use Any time before pregnancy 16 (38%) 19 (30%) 0.49 Stop at + pregnancy test/1 st trimester 8 (19%) 4 (6%) 0.09 Start/continue 1 st trimester 7 (17%) 10 (16%) 0.89 Start in 2 nd trimester 5 (12% ) 0 0.02 Start in 3 rd trimester 2 (5%) 0 0.30 Post-partum flare 11/34 (32%) 22/49 (45%) 0.36 Continuous variables were compared using Mann-Whitney test; categorical variables were compared using Chi-square with Yates’ correction or Fisher’s exact test. Medications resumed to treat flare were steroids (29 pregnancies), csDMARDs (14 pregnancies) and TNF-inhibitors (7 pregnancies: 5 during the 2 nd and 2 during the 3 rd trimester). A post-partum flare was registered in 33/83 (40%) of cases, without difference between ‘flare’ group vs ‘without flare’ group (Table 1), as well as between PsA vs ‘other SpA’ pregnancies (47% vs 33%, p=0.2). Conclusion In this cohort of SpA pregnancies, 40% experienced a flare during pregnancy and 40% during post-partum. Flares occurred more frequently in the 2 nd trimester and especially in patients with axial involvement, requiring the start of a TNF-inhibitor during the 2 nd or the 3 rd trimester in 7 pregnancies. Having a flare during pregnancy was not associated with a post-partum flare. Disclosure of Interests None declared